Anaesthesia on the Move PDF
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Anaesthesia on the move This page intentionally left blank Anaesthesia on the move Authors: Sally Keat, Simon Townend Bate, Alexander Bown and Sarah Lanham Editorial Advisor: Peter Matthews Series Editors: Rory Mackinnon, Sally Keat, Thomas Locke and Andrew Walker First published in GreatBritain in2012by Hodder Arnold, animprint ofHodder Education, adivision ofHachette UK 338EustonRoad, LondonNW13BH http://www.hodderarnold.com #2012Keat, Townend Bate,Bown, Lanham All rights reserved. Apartfromanyuse permitted under UK copyright law,this publicationmayonlybereproduced,storedortransmitted,inanyform,orbyanymeans withprior permission inwriting ofthe publishers or inthe case of reprographic production in accordance withthe terms oflicences issued bythe Copyright Licensing Agency. In theUnited Kingdom such licences areissued bythe Copyright Licensing Agency: Saffron House, 6(cid:2)10Kirby Street, LondonEC1N 8TS. Whilsttheadviceandinformationinthisbookarebelievedtobetrueandaccurateatthe dateofgoingtopress,neithertheauthor[s]northepublishercanacceptanylegal responsibilityorliabilityforanyerrorsoromissionsthatmaybemade.Inparticular,(but withoutlimitingthegeneralityoftheprecedingdisclaimer)everyefforthasbeenmadeto checkdrugdosages;however,itisstillpossiblethaterrorshavebeenmissed.Furthermore, dosageschedulesareconstantlybeingrevisedandnewside-effectsrecognized.Forthese reasonsthereaderisstronglyurgedtoconsultthedrugcompanies’printedinstructions, andtheirwebsites,beforeadministeringanyofthedrugsrecommendedinthisbook. British Library Cataloguing in Publication Data A cataloguerecord for thisbook is available fromthe British Library Library ofCongress Cataloging-in-Publication Data A catalogrecord for thisbookis available from theLibrary ofCongress ISBN-13 978-1-444-12153-7 1 2 34 5 6 7 89 10 Commissioning Editor:Joanna Koster Project Editor:Stephen Clausard Production Controller: Francesca Wardell CoverDesign: Amina Dudhia Indexer: Laurence Errington Coverimage #LTH NHSTrust/Science PhotoLibrary Typeset in10/12ptAdobe Garamond ProRegularbyDatapage PrintedandboundinIndiabyReplikaPress Whatdo youthinkabout this book?Or any other HodderArnold title? Please visit ourwebsite:www.hodderarnold.com This eBook does not include access to the Skyscape app that was packaged with the printed version of the book. Contents Preface ix Acknowledgements xi List of abbreviations xiii An explanation of the text xvii PART I: PRE-OPERATIVE 1 1. Physiology 3 1.1 Homeostasis 3 1.2 Respiratory physiology 4 1.3 Cardiovascular physiology 16 1.4 Neurophysiology 24 2. Preparing for surgery 36 2.1 Basic principles of anaesthesia 36 2.2 Pre-operative assessment 36 2.3 Assessment of surgical risk 39 2.4 Assessment of airways 41 2.5 Investigations to consider 43 2.6 Pre-operative medications 44 2.7 Management of regular medications 45 2.8 Management of pre-operative conditions 47 2.9 Reduction of aspiration risk 51 2.10 Informed consent 52 PART II: PRACTICE OF ANAESTHESIA 55 3. In the anaesthetic room 57 3.1 Introduction 57 3.2 Induction 58 4. Airways and ventilation 65 4.1 Airways 65 4.2 Ventilation 71 5. Oxygen 76 5.1 Initiating oxygen therapy 76 5.2 Administering oxygen 77 5.3 Monitoring saturation of haemoglobin with oxygen 79 vi Contents 6. Local and regional anaesthesia 84 6.1 Advantages to regional anaesthesia 84 6.2 Anaesthesia and analgesia within the spinal column: central neural blockade 84 7. Drugs in the anaesthetic room 89 7.1 General anaesthetics 89 7.2 Muscle relaxants: neuromuscular blockers 93 7.3 Anti-cholinesterases 94 7.4 Local anaesthetics 95 8. In the operating theatre 100 8.1 Delivering anaesthesia 100 8.2 Intra-operative monitoring 105 8.3 Intra-operative emergencies and complications 110 PART III: ON THE WARDS 117 9. Post-operative complications 119 9.1 Common complications 119 9.2 Sepsis 121 9.3 Pain 123 9.4 Analgesia 127 9.5 Post-operative nausea and vomiting 131 9.6 Acute blood loss 133 10. Post-operative fluids 135 10.1 Fluid requirements 135 10.2 Fluid compartments 136 10.3 Replacement fluids 138 10.4 Fluid prescribing 139 10.5 Fluid balance abnormalities 139 10.6 Electrolytes 142 11. Recognizing and managing ill patients 153 11.1 Introduction 153 PART IV: INTENSIVE THERAPY UNIT/CRITICAL CARE 159 12. Structure of an intensive therapy unit 161 12.1 Introduction 161 12.2 Admission 162 12.3 Staff 162 Contents vii 13. Principles of critical care 165 13.1 Organ support 165 PART V: SELF-ASSESSMENT 173 14. Pre-operative 177 Questions 177 Pre-assessment: EMQS 177 Pre-assessment: SBAS 178 Answers 180 Pre-assessment: EMQS 180 Pre-assessment: SBAS 181 15. In the anaesthetic room 183 Questions 183 Airway management: EMQS 183 Airway management: SBAS 184 Answers 185 Airway management: EMQS 185 Airway management: SBAS 187 16. Practice of anaesthesia 188 Questions 188 Maintenance of anaesthesia: EMQS 188 Maintenance of anaesthesia: SBAS 189 General anaesthesia: EMQS 189 Fluid: EMQS 190 Fluid: SBAS 191 Electrolytes: EMQS 191 ECG: SBAS 192 Oxygen: EMQS 193 Oxygen: SBAS 194 Answers 195 Maintenance of anaesthesia: EMQS 195 Maintenance of anaesthesia: SBAS 196 General anaesthesia: EMQS 196 Fluid: EMQS 196 Fluid: SBAS 197 Electrolytes: EMQS 198 ECG: SBAS 198 viii Contents Oxygen: EMQS 199 Oxygen: SBAS 199 17. Drugs in the anaesthetic room 201 Questions 201 Induction of anaesthesia: EMQS 201 Induction of anaesthesia: SBAS 203 Answers 204 Induction of anaesthesia: EMQS 204 Induction of anaesthesia: SBAS 206 18. On the wards 207 Questions 207 Pain management: EMQS 207 SEPSIS: EMQS 209 Volatile gases: EMQS 211 Regional anaesthesia: SBAS 212 Regional anaesthesia: EMQS 213 Pre-operative medications: EMQS 213 Answers 214 Pain management: EMQS 214 SEPSIS: EMQS 215 Volatile gases: EMQS 217 Regional anaesthesia: SBAS 218 Regional anaesthesia: EMQS 218 Pre-operative Medications: EMQS 219 19. Resuscitation and emergencies 220 Questions 220 Intra-operative emergencies: SBA 220 Muscle relaxants: EMQS 220 Advanced life support: EMQS 221 Advanced life support: SBAS 222 Answers 223 Intra-operative emergencies: SBAS 223 Muscle relaxants: EMQS 223 Advanced life support: EMQS 223 Advanced life support: SBAS 224 Index 225 Preface Anaesthesiaisanexciting,rapidlychangingspecialty.Itislovedbystudentsfor its practical nature and reputation as being at the sharp end of patient care. Anaestheticsisalsoinextricablylinkedwithphysiologyandpharmacology.This makesitanidealtopictohelpbridgethegapbetweenbasicsciencesandclinical medicine.Writtenbystudentsforstudents,thisshortguidetoanaestheticsalso gives awhirlwind tourofhuman physiology. We aimedto giveinformation in as many different styles as possible, keeping the text engaging. We hope this briefguide willgive you:thetoolstohandleanemergency situation,theablity to optimise a patient both peri-operatively and on the ward and, most importantly (!), withstand a grilling on your anaesthetics placement. AUTHORS: Sally Keat BMedSci MBChB (cid:2) Foundation Year 1 doctor, Northern General Hospital, Sheffield, UK Simon Townend Bate BMedSciMBChB (cid:2) Foundation Year 1 doctor, Barnsley Hospital, UK Alexander Bown MBChB (cid:2) Foundation Year 2 doctor, Sheffield Teaching Hospitals, UK Sarah Lanham MBChB (cid:2) Foundation Year 2 doctor, Sheffield Teaching Hospitals, UK EDITORIAL ADVISOR: Peter Matthews (cid:2) Consultant Anaesthetist, Rotherham NHS Foundation Trust, Rotherham, UK EDITOR-IN-CHIEF Rory Mackinnon BSc MBChB (cid:2) Foundation Year 2 doctor, Northern General Hospital, Sheffield, UK SERIES EDITORS: Sally Keat BMedSci MBChB (cid:2) Foundation Year 1 doctor, Northern General Hospital, Sheffield, UK Thomas Locke BSc MBChB (cid:2) Foundation Year 1 doctor, Northern General Hospital, Sheffield, UK Andrew Walker BMedSciMBChB (cid:2) Specialist Trainee Year 1 doctor in Medicine, Chesterfield Royal Hospital, Chesterfield, Derbyshire, UK
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